Open Letter to Governor Murphy: Urgent Call for Staffing in Nursing Homes and Assisted Living Facilities

PRINCETON, N.J., May 1, 2020 /PRNewswire/ -- Open Letter to Governor Murphy from Dr. David R. Barile:

Dear Governor Murphy:

I am a Geriatrician in active practice in Princeton.  I am the founder and Chief Medical Officer of Goals of Care Coalition of NJ, a sixteen-member organization that works to improve Palliative Medicine services across our state.

In addition, I am the Medical Director of Geriatric and Palliative Services, and the Geriatric Section Chief at UPENN Hospital of Princeton.  My private medical practice includes making daily rounds in our hospital, as well as local skill nursing and assisted living facilities in our region. I am also in daily close contact with physicians and administrators of such facilities across the state.

For the previous two weeks on my morning rounds in a local nursing home, my tasks include not just listening to breathing and heart sounds but also offering food and water to those suffering from hunger and thirst.  Residents are confined to their rooms and many staff members are out sick with COVID.  I find myself offering food and drink whenever I'm in a patient's room.

This morning, I was feeding one elderly resident when I heard staff yelling across the hall. In that room I found a patient in cardiac arrest. I administered CPR to no avail, and pronounced her dead at 8:50 am.  With no recent fever or illness, I surmise that she died of a sudden blood clot, presumably from COVID or perhaps from being less mobile during her confinement.

I consoled the staff and made that difficult call to her daughter.  When I returned to the bedside of my original patient who I was feeding, the food had turned cold and she had dozed off, having eaten very little.

I can only assume, based on the fact that many nursing homes and assisted living facilities remain dangerously understaffed, that your knowledge of their operations is limited.

It's important to understand - nursing aides assist patients with getting out of bed, bathing, dressing and meals. Dining typically occurs around a table, where residents interact, and one aide can assist with meals. However, at this time, every nursing home and assisted living patient is confined to their room, isolated from contact, and dependent upon dwindling staff for basic needs. 

As of this letter's date, over 90% of NJ nursing homes have cases of COVID.  Approximately 40% of the many deaths in our state occur in nursing homes.  NJ nursing home deaths from COVID are consistently high and will continue to rise. It is my estimation that without immediate hands-on assistance in these facilities, NJ will lose 30% of our elder population who reside there.  That number will be staggering.  Not all deaths will be from COVID.   They will also die from bedsores, malnutrition, and other maladies associated with lack of basic care and hygiene.

In this time of crisis, the state of NJ has made three essential decisions that impact nursing homes.

In March, your office suspended all staffing regulations for nursing homes as many staff members would be out sick, and facilities would not be able to maintain state required, patient to staff ratios.  This was important, because with so many out, virtually every facility in NJ would have been in violation. Good for avoiding a violation, but unhelpful to our frail elders.

On March 31^st, Commissioner of Health Judith Persichilli mandated that "no patient/resident shall be denied re-admission or admission to the post-acute care (AKA Nursing Home) setting solely based on a confirmed diagnosis of COVID-19."  This move was likely to maintain throughput for hospitals, out of worry that they would fill up and be unable to discharge people back to nursing homes.  Again, helpful to hospitals, but not for nursing homes.

More recently, fearing that families were not getting information from facilities, Commissioner Persichilli pushed for the public release of COVID positive cases and deaths for every nursing home. Again, important and useful information especially if you are a concerned loved one and locked out of your Mom or Dad's home, but how exactly does this help the patients living in those nursing homes?

In these facilities, where today nearly 40% of our COVID deaths occur and where our most vulnerable population resides, state government has made no provision to assist with staffing. This desperate situation needs to be addressed immediately. How could a government and its health department allow a health care business to operate knowing that deaths will increase without staffing support?

As of today, all you have done for our sickest, most frail population is to loosen requirements and turn on the lights so everyone can watch as cases climb, and more people die.  Last week, you stated that health care workers from out of state are available and will be coming to help.  My understanding from the NJ Emergency Operations Center is that these volunteers are staffing Emergency Field Hospitals (which are not at capacity). Good for the locals, again unhelpful to our elderly population.

I understand that you recently met with President Trump and PPE will soon be sent to NJ Nursing homes. That's good, it will replace trash bags and raincoats that many in nursing homes and assisted living facilities are using.  We hope they arrive soon. But is does not address with most pressing issue: the staffing.

On April 16^th, I sent a letter to you and Commissioner Persichilli pleading for our National Guard to assist staff in the most threatened NJ nursing homes and assisted living facilities. The Guard has been called out to three facilities in the state overwhelmed by COVID and are currently assisting with testing in the field.

We also need guardsmen.  We need them in our vulnerable nursing homes to help with critical staff shortages so residents can be fed, washed, clothed and safely cared for in their rooms. This intervention will save lives and reduce age related complications of remaining bedbound. Guardsmen will help to reduce the spread of COVID by keeping residents with dementia from moving room to room. 

The state needs to hear from you regarding this unacceptable situation.

If the National Guard is not available, one solution may be to extend a waiver allowing healthy young adults to volunteer in nursing homes.  College students or healthy volunteers may don PPE and help feed ? under close supervision of existing staff ? elderly residents.   Whatever the mechanism, nursing homes have an immediate staffing crisis that is threatening the lives of New Jersey's most vulnerable population.

Without an immediate and compassionate response from you, there is concern that a Title 59 notice of tort claim could be submitted on behalf of families who have lost elderly loved ones in our state. We should work together to prevent this, and quickly come up with innovative and compassionate  ways to care for elders in long term care and assisted living facilities.

In our state and across the nation, hospital staffs are regarded as heroes. In my local hospital we receive cards from school children.  I pass signs of support on the hospital lawn when I enter each day. We receive salutes from local law enforcement and firefighters, and gratitude from families and patients. 

Meanwhile, we shame nursing homes for not doing a good job to contain the virus, and frown upon them as numbers climb. I ask state officials and the general public to not write off NJ nursing facilities.  How many deaths will it take before our government intervenes?  

Twenty-five years ago, when I was an intern, I shared my interest in geriatrics with a senior educator in my program. He responded dismissively, with a comment that has haunted me ever since.  I've tried not to think about those words over the course of my career.  I did not want to believe them.   Twenty-five years later, it's occurring to me that what he said may be tragically true:  "Nobody gives a damn about old people."

Respectfully submitted, 

David Barile, MD

CC: Lt. Governor Sheila Oliver, George Helmy Chief of Staff, Deputy Chief of Staff of Outreach Deborah Cornavaca, Commissioner of Health Judith Persichilli, Chief of Staff Andrea Martinez-Mejia, LTC Ombudsman Laurie Brewer, Joseph Vitale, Chair, and Fred Madden, Vice Chair, Health, Human Services & Senior Citizens Committee NJ Senate, Valerie Vainieri-Huttle, Chair, and Shanique Speight, Vice Chair, Aging & Senior Services Committee, NJ Assembly.

SOURCE David R. Barile, MD, LLC